American Pragmatism and the Healthcare Crisis

American Pragmatism and the Health Care Crisis                            Gerry O'Shea                  July 2017

The American way of solving problems is often spoken of as pragmatic. In this approach the truth of any idea is determined by its practical outcomes. Every proposal is viewed not through the prism of some theoretical principle or dogma but is judged solely on its actual impact on people's lives.

Consider the American health care system and, for now, leave aside any consideration of ideology and assess the way we deal with this vital issue strictly from a pragmatic viewpoint where only results matter.

The annual per capita spending for health care in the United States comes to $9451, but about 40 million people have no coverage of any kind. After all that spending, you might expect that American life expectancy of 79 years would be at the top of the international ratings. Not so. In our nearest neighbor, Canada, where everybody is covered at a cost of $4608 per person, longevity is 82 years.

A few more examples highlighting cost and extent of coverage in other Western democratic countries are instructive. In Germany where people on average live to the age of 81 and health insurance is mandated for everybody, the per capita cost is $5267. In Japan the cost per person for health insurance is $4150 and, on average people live five years longer than in the US - again universal health insurance is required by law there.

Staying with pragmatic considerations, how do the millions of uninsured people manage in the United States? They get no preventive care, no check-ups which often identify medical problems early and allow for lifestyle changes or palliative medications. So when they get sick they are rushed to the nearest emergency room where the cost of treatment is at a premium.

Economic and practical considerations alone strongly indicate that having  tens of millions of uninsured people who can't afford preventive care is a very inefficient and wasteful way to organize a health coverage system.

Where is the famous American pragmatism which works in many other areas of the economy? We are paying far more than other Western countries but living shorter lives, and tens of millions of our citizens have no medical coverage. Leaving aside for now  humanitarian considerations, just from a business point of view, this is a dreadful deal.

President Trump and most of his cabinet are billionaire business people. We were told repeatedly during the Presidential campaign about all the problems that the Obama and Bush leadership teams failed to solve because of incompetence. Stand back and just watch how the super-rich apply business acumen to running the country.

Obamacare was and still is their first big  bete noir and candidate Trump  promised daily to scrap it. However, in doing so he promised that  there would be no cutbacks in Medicare or Medicaid  and somehow deductibles and co-payments would also be trimmed. Trumpcare would increase the number of people covered while ending the Obama mandate that required all citizens to buy health insurance.

Well the Healthcare Bill that passed the House of Representatives with the enthusiastic support of the White House, according to the independent Congressional Budget Office, would end coverage for over 22 million people by massively reducing federal Medicaid payments to the States. The President was elated that the Bill passed, and he invited all the House Republicans for an unprecedented celebratory drink in the White House.

A few weeks later as he tried to persuade moderate Senators to vote for Senate leader McConnell's proposals, he called the House effort "mean." Then he tweeted that Obamacare should just be repealed and the messy business of replacing it could be dealt with at a later date. That would result in 32 million being removed from coverage. Honestly, you can't make this stuff up!

Pulling back from all this talk about fixing or replacing Obamacare, one has to ask why the United States, the most powerful and richest country in the world, doesn't have a health care policy that covers all residents. The other Western democracies cover all their citizens, irrespective of age or income.  Why is America different?

Excluding millions who can't afford to pay insurance premiums does not meet acceptable humanitarian standards. The present inhumane policy of the survival of the fittest demeans our democracy.

Obamacare, while well short of providing  universal care, brought coverage to millions previously uninsured. All the emerging Trumpcare proposals instead of expanding the numbers covered have the very opposite effect.

More than 80% of evangelical Christians and close to 60% of non-Hispanic  white Catholics supported Trump last November. Yet I see no evidence of a Christian influence in White House policies, especially in this vital area of life and death for so many where the poor are really vulnerable.

Adding insult to injury, the money saved in Medicaid, which mostly helps the poor, by any version of the Republican proposals goes mostly in massive tax savings for the rich. This is not hidden or camouflaged in any way - Robin Hood in reverse in broad daylight. The amount involved hovers around 700 billion.

Maybe we should set aside moral considerations about  Trumpcare  and not consider the repeated biblical injunctions about how the poor should be treated. It may well be more productive  to concentrate on the pragmatic arguments for radical change because the present system costs far too much and fails to cover millions of citizens.